Summary
Objective
Onset of epilepsy before 2 years of age is associated with poor cognitive outcome; however, the natural course of the range of epilepsies that occur at this age is unknown. The aim of this prospective community‐based study was to investigate the neuropsychological development of infants with newly diagnosed epilepsy longitudinally and to identify the clinical factors that predict long‐term impairment.
Methods
Sixty‐six infants <24 months of age were enrolled in the baseline phase of this study; 40 were seen again at 1‐year follow‐up and 40 at 3‐year follow‐up. Children underwent a neurological and neuropsychological assessment at each time point.
Results
More than 55% of children demonstrated impaired cognitive functioning at each assessment, with a similar percentage showing impaired memory and attention at 3‐year follow‐up. Cognitive scores obtained at each time point were correlated. More than 20 seizures/seizure clusters prior to assessment and an abnormal neurologic examination predicted poor cognitive functioning at baseline, whereas continuing seizures and baseline cognitive score predicted 3‐year intelligence quotient (IQ)/cognitive score.
Significance
These findings demonstrate the following: (1) infants who are performing poorly at baseline continue to display impaired development at follow‐up, (2) these children are delayed across a range of neuropsychological functions, and (3) a high number of seizures close to initial diagnosis and continuing seizures at follow‐up independently predict cognitive impairment. These findings help to identify those infants with new‐onset epilepsy who are most at risk for poor developmental outcome and suggest that multimodal interventions should be instituted early in the course of the disorder to improve outcomes.
NOV